The long-range goal of this project is to determine the extent to which psychological and social characteristics of patients with coronary heart disease (CHD) are determining outcomes of the disease process, independently of associated clinical, anatomic and hemodynamic factors. All patients undergoing coronary arteriography at Duke will be characterized in terms of psychological makeup (MMPI), Type A behavior pattern, life events stress, social supports and functional capacity (quality of life); each patient will be followed at six months and annually thereafter with regard to pain status, mortality, myocardial infarction, work status and quality of life. About 1/3 of the 480 patients evaluated per year will be treated with coronary bypass surgery. Two parallel series of investigation are proposed. First, the independent relation of psychosocial factors to the pain, mortality and myocardial infarction and quality of life outcomes will be evaluated using both multiple logistic and Cox model analytic techniques. These analyses will test whether Hy and Hs scales on the MMPI and baseline work status are predictive of pain relief at followups beyond the already documented six month interval as well as whether other psychosocial factors (especially marital status, Type A behavior and depression) are predictive of the other outcomes cited above. Second, item and factor analytic approaches will be used to identify "CAD scales" based on MMPI items which discriminate among patient groups with varying levels of arteriographically documented coronary atherosclerosis. The validity of these scales will be evaluated by comparing scales among Japanese cohorts with and without CHD, as well as through retrospective scoring and followup among college populations that completed the MMPI 20-30 years ago. Findings of these studies could help to improve the treatment of current CHD patients, and to define the role of psychosocial factors in etiology and pathogenesis of CHD.